The diagnosis of asthma in children: An evidence-based approach to a common clinical dilemma

Abstract

On a global scale, asthma is the most common chronic non-communicable disease in children. It is a heterogeneous condition characterised by chronic inflammation and variable expiratory airflow limitation, [1] as well as airway reversibility (evidence level C). Airway inflammation and airway obstruction are features of asthma and are usually not measured in young children, except in research settings. The term asthma, therefore, should not be used to describe preschool wheezing illness. [2] The child should demonstrate clinical improvement during 2-3 months of controller treatment, with worsening of symptoms after treatment cessation. [3] A history of other allergic disease (eczema or allergic rhinitis) or asthma in firstdegree relatives is useful in some instances (evidence level B). Objectives We reviewed the current literature on the diagnosis of asthma in children, with particular emphasis on young children and the available evidence. We also examined the assessment of asthma control in children and the current evidence basis for the importance of these assessments. Methods The South African Childhood Asthma Working Group (SACAWG) convened in January 2017 with six task groups, each assigned to a section leader (Appendix A), who constituted the editorial committee on assessment of asthma epidemiology, diagnosis, control, treatments, novel treatments and self-management plans. The task groups reviewed the available scientific literature on the diagnosis of asthma and assessment of asthma control in young children according to high-quality evidence, graded the level of evidence, and made recommendations based on the literature (Appendix B). This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Challenges in the diagnosis of asthma in children, what are the solutions? A scoping review of 3 countries in sub Saharan Africa

“…Health worker education Training health workers at all levels of the health system Murdoch et al [ 53 ] c. Capacitation of health facilities with diagnostic equipment and asthma drugs Need for innovative confirmatory tests for childhood asthma for children under 5 years of age Nantanda et al [ 22 ] Availing spirometry to confirm asthma diagnosis. Training health workers on use of spirometry Ayuk et al [ 35 ], Desalu et al [ 38 ], Nwosu et al [ 42 ], Obaseki et al [ 43 ], Adeyeye et al [ 54 ], Masekela et al [ 55 ] …”

Childhood asthma: A best-practice strategy for the diagnosis and assessment of control in South Africa

“…Peak expiratory flow (PEF) measurements or preferably spirometry can be used (Table 3). [10] Normal tests do not exclude the diagnosis of asthma. [11] In the case that the history is suggestive of asthma, and the spirometry does not support the diagnosis, other specialised tests such as exercise bronchoprovocation or methacholine challenge may be done by a pulmonologist to confirm the diagnosis.…”

“…The long-term goals of asthma management include the following: • to achieve good symptom control • to maintain normal activity levels • to minimise future risk of asthma-related mortality • to reduce exacerbations • to maintain lung function and normal lung development • to minimise side-effects of treatment • to provide a written action plan • to consider the patient's own goals with regard to treatment Table 3. Confirmation of variable airflow limitation with PEF or spirometry (adapted from Masekela et al [10] )…”

How Do Pediatricians Diagnose Asthma in Tertiary Care Hospitals?

“…But all these guidelines concur on three components of the asthma definition, i.e., recurrence of symptoms, airflow obstruction with evidence of reversibility, and the presence of chronic inflammation. The majority of the guidelines have been emphasizing the first two components for the diagnosis of asthma, partly due to the non-availability/cost of equipment to measure chronic inflammation [ 8 - 10 ]. However, they have been stressing that airflow obstruction and reversibility should not only be observed subjectively but also be objectively measured with peak flow meter (PFM), bronchodilator reversibility, bronchial challenge testing, or obstructive spirometry [ 1 , 4 , 5 ].…”